In our institute in the Netherlands we treat patients suffering fromsmall fiber neuropathy with an integrative medicine concept, and one ofthe pillars are topical creams. Here a patient tells his story sufferngfrom serious pains treated with a compound cream consisting ofisosorbide dinitrate, lidocaine and capsaicine. The pain decreased 50%in intensity after a treatment period of 1 week. Small nerve fibers arethe nerve fibers in the skin that carry specific sensation's. Thesefibers are unmyelinated, and the impuls conducion is slow. These smallnerve fibers carry mostly pain and temperature sensation. Thisneuropathy is considered a separate clinical entity from a regularlarge-fiber polyneuropathy. Small fiber neuropathy is difficult todiagnose, as the EMG findings are basically normal.

April 2010, David J. Kopsky, MD  and Jan M. Keppel Hesselink, MD, PhD 

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